Sounding board. Quality assessment and quality assurance: the performance-review alternative.

The medical profession, apparently obsessed with the need to prove itself, has come up with no less than three approaches to assessing, and assuring the public about, physician competence. Two of these approaches — awarding credit for evidence of participation in continuing medical education (CME) and recertification of specialists through written examinations — have received the most attention. An editorial in the Journal last year discussed their relative merits and the ways in which specialty boards could use these approaches and others.1 The third approach, evaluation of actual patient care by assessment of the physician's performance, has received less attention . . .